Secret Diary of a Cardiology SpR Monday If you’ve been following this column then you’ll know that Douglas, my boss and mentor, recommended I take a Fellowship overseas before settling down as a consultant. He suggested Melbourne but I chose California. That was how I ended up cramming my face full of ultra low fat skinny blueberry muffins at 6am every day as we started rounds. It’s also how I ended up spending Friday mornings on the beach learning how to surf. Not a bad life. Monday was pretty dull. James (think Hawaiian surfer dude) was the attending on the wards. He is surprisingly meticulous for someone who wears faded jeans and an Aloha shirt and makes sure that all the patients have plans for the week. I spend the afternoon doing an echo list before finishing some paperwork and heading home for an early night. My apartment has a great view of the Pacific but it also has ‘Showtime’ which is a combination of Sky Movies, cable and every other type of great TV, so I end up spending the night drinking a glass of Californian red and watching seasons premieres of shows I have never heard of.
Tuesday Angio list this morning. The attending in charge is Suzie, a young woman not much older than myself, and like all the cardiologists here she is pretty meticulous. Perhaps the constant fear of litigation is what drives them. Everything is heavily supervised, especially the complicated case that we start with. There is a window on the second floor with a small gallery and a professor talks through what I’m doing with a group of medical students. The case goes smoothly and we soon start another and then another. The pace of work is frantic but unlike back home everything seems to run exceptionally smoothly. The assistants and nurses are eager and willing to help, the equipment is always ready and in perfect working condition, and the computer systems to help us do our job are first rate. I guess this is what it would be like if they privatised the NHS.
Wednesday Early rounds again and then a morning of teaching. The students here really know their stuff and some of their questions leave even me thinking for a moment before I can compile an answer. After lunch I see some ward patients and spend an hour catching up on emails. I go out with some of the other residents in the evening and we hit a couple of bars in the centre of town. My colleagues don’t usually drink a huge amount and I find myself getting blank stares when I suggest a third round. Still, they all buy into it and we end up moving onto a gothic club where we look decidedly out of place. The bouncers laughed at us when they let us in and most of the patrons keep out of our way but we end up dancing all night and I crash back in my flat sometime around 2am.
Thursday I feel decidedly unwell as we start rounds a mere four hours later but I look significantly better than some of my colleagues who don’t stay out late very often. It takes several coffees and a double bacon roll (the lady in the canteen looks at me as if I’m mad when I order 18
* Names have been changed to try to keep our cardiology SpR in a job though she’s doing a pretty good job of trying to lose it without our help!
this instead of the skinny muffin everyone else is having) before I feel better. After lunch I leave the building with Suzie and we go downtown to the weekly inner city clinic that the hospital runs as part of its charity outreach programme. Most of the patients have standard stuff but towards the end we find a man in his forties who is really sick. He has no cardiac history but has been getting chest pains and shortness of breath for a few weeks and is now in crushing pulmonary oedema. Suzie looks anxious when he tells us what we already know - that he doesn’t have any health insurance. We tell him that he has to get checked into a hospital and suggest the local one where they will look after him immediately. He doesn’t want to pay for an ambulance so a friend agrees to drive him there. After clinic, I go out for dinner with Suzie and we talk about his case. If he had turned up in the UK he would have had a battery of blood tests, a chest x-ray, an echo and a cardiac MRI within an hour of setting foot through the door. If we had found something stentable the chances are that we would have done an angio tonight and sorted it out. By tomorrow morning he would have been in coronary care eating a skinny blueberry muffin like everyone else.
Friday Wave rounds today which means surfing at dawn for the whole team. We meet for breakfast in a hut on the beach and sit in our usual corner table as we do a paper round of our patients. As we talk, Suzie walks to the juice bar to order some more drinks and makes a call on her phone as she does. When she comes back she tells us that the man from yesterday died early this morning. It turns out he did get to the hospital but aside from an ECG and some blood tests he didn’t have much else as they were too stacked up with patients. He arrested a couple of hours ago and they couldn’t revive him. There’s a silence after she finishes as we all look at each other. James explains to the students that based on the clinical story he may have died anyway but as he does so he gives Suzie and I a look that says otherwise. My six months are nearly up and as I reflect on this in my apartment that night. I wonder which system I’d rather practice in. The NHS has many faults but, like the army, they leave no man behind. However, what’s the point in training to be a cardiologist in the developed world if you can’t treat some of your patients in the best possible way using the best technology? Is it better to treat all your patients to a good degree or treat some of them to a fantastic degree whilst leaving some of them with nothing? I’m not sure that I know the answer to that any more.
Published on Feb 19, 2010